乾癬 治療에 있어서 Methotrexate의 투여방법에 관한 연구 = The Study for Method of Administration of Methotrexate in Psoriasis

다국어 초록 (Multilingual Abstract)

For decreasing of the toxic reaction of Methotrexate in treatment of psoriasis, many authors studied about the doses schedules in administration. We studied previously about clinical effects and side reactions of Methotrexate in 33 psoriatics and found out of the similar effects between the method of large single doses and small daily doses12). Rall considers liver cell may store Methotrexate at least 64 hours depending on cell turnover and platelets life span was 8-9 days and leukocyte life span was 6-11 days. For decreasing of hepatotoxic reaction, more short period of administration and at least 3 days resting period is need respectively16).
Seven men and six women were studied, ranging in age of 21 to 69 years old. Eleven of these 13 patient had previously received oral and local corticos-teroid therapy but no antifolic agent and two patient had received oral Methotrexate 5mg in divided doses for 7 days with 3 days resting period.(7X 7 method). Methotrexate 2.5mg tablet administered to all of 13 cases 2 times or 3 times a day for 3 days and followed by 3 days resting period (3X3 method). This method was repeated from 2 to 4 course on accordance of patient's condition. Complete blood count, urinalysis, alkaline phosphatase, serum glutamic pyruvic transaminase, thymol turbidity and serum bilirubin were performed before Methotrexate were used. Repeated SGPT on begining and finishing of each course of methotrexate administration were carried out. The degree of improvement was noted on I to IV scale and was always evaluated by the same observer. I was cessation of scaling, II was less erythema and infiltration, III was marked diminution of erythema without infiltration, and N was almost no erythema.
All of the patients Showed improvement of involved skin(Table 1) In 6 of the 13 patients the improvement maximal IV improvement was noted; in 4 patients III improvement was noted; in 2 II patients 11 inlpr-ovenlent was noted; in one patient I
improvement was noted.
The side effects appeared in 4 patients with symptoms of anorexia, headache, dizziness and herpes somplex labialis. (Table 1.)During treatment, anemia was not appeared but there were leukopenia and thrombocytopenia in hematologic examination of the most patients. Before medication, SGPT was all n after administration of Methotrexate SGPT levels increased in all Patients but only 4 showed above the normal. In 5 of the 13 patients elevated by SGPT by administration of Metllotrcyate was decreased by the three days resting period(Table 2). Conclusively after study of 13 psoriatics with 3 x 3 method of Methotrexate administration, following results are obtained.
1) More shortening the time of of improvement of psoriatic skin lesions than 7x 7 method.
2) Clinical side effects decreased to 30% in 7x7 method.
3) Two of the 13 patients, who showed side reactions by 7X7 method
Previously, showed no clinical side reactions by 3x3 method.
4) The SGPT level showed more slow going curve in elevation 3x3 method, by 7x7 method.
5) 3x3 method may be not always reasonable in all patient but it can be started by one tablet at first
day with gradually increasing to 3 tablets a day and can be continued for 3 days in accordance with patient's condition as upper limit and must have resting period at least more than 3 days.